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Getting the Virginia Health Insurance Plan You Need

The Affordable Care Act and Virginia

Virginia currently ranks 26th in the U.S. in terms of healthiness, according to America's Health Rankings, primarily due to high incidences of diabetes and infant mortality in the state*. Currently, Virginia has approximately 823,000 uninsured residents and it is estimated that almost two-thirds of these -- 63% -- qualify for financial assistance to help pay for their health insurance premiums**.

This number should include yourself and any dependents you'll claim on your 2018 (or most recent) tax return (even if they don’t live with you).

Enter the taxable income from your 2016 (or most recent) income tax return, and adjust for changes to your income and deductions for 2017.

You may qualify for Obamacare if someone in your household has had a qualifying life event either 60 days before or after today.

Your insurance options may be limited if you have any of the following pre-existing conditions:

AIDS/HIV

Bipolar Disorder

Cancer

Cirrhosis

Depression Requiring Hospitalization

Diabetes Type I

Erythematous

Heart Disease

Kidney/Renal Failure

Muscular Dystrophy

Schizophrenia

Systemic Lupus

Transplant History

There are 2 types of health insurance plans:

Obamacare plans:

Offers government discounts to qualifying shoppers

Usually offers more benefits than short-term plans

Cannot deny you coverage for pre-existing health conditions

Only available during the Open Enrollment Period or if you have a qualifying life event

Lower Cost plans

Doesn't save you from paying a government tax penalty

Doesn't always cover preventive, routine care

Have generally lower monthly costs

Are available to shoppers year around without needing a qualifying life event

Plan types can determine the hospital and doctor networks, coverage levels and benefits.

Platinum plans are designed to cover an average of 90% of out-of-pocket medical costs. That's more than any other metal level. But due to its generous cost sharing, platinum plans have the highest monthly costs.

Gold plans are designed to cover an average of 80% of out-of-pocket medical costs. That means you can save a lot of money on your medical bills but have to pay extra monthly.

Silver plans are Obamacare's standard plan. They are designed to cover an average of 70% of out-of-pocket medical costs and are the only plans that qualify for cost sharing reductions. Because these plans adequately save you on your medical bills, the cost of silver plans are more modest.

Bronze plans are designed to have the lowest monthly cost. They do this by only covering an average of 60% of out-of-pocket medical costs. If you can afford to pay more during an emergency, these plans can save you a lot each month.

Catastrophic plans are the cheapest plan you can get and only provides the minimum essential coverage. Because these plans cover so little, only people under 30 or those with limited incomes can qualify for these plans.

Acupuncture is a form of alternative medicine involving thin needles inserted into the body at acupuncture points. It can be associated with the application of heat, pressure, or laser light to these same points. Acupuncture is commonly used for pain relief, though it is also used for a wide range of other conditions.

Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery).

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer cells.

Chiropractic care is a natural form of health care that uses spinal adjustments to correct misalignments and restore proper function to your nervous system.

Your share of costs for a covered service, typically after you meet your deductible and copayment charges. For example, once you meet your deductible, you might pay 20% and your health insurance plan pays 80%, based on the plan you choose. Once you have met your plan's annual out-of-pocket maximum, your plan pays 100% of the costs for covered services.

This is the highest amount you are required to pay towards your medical care in a year, including your deductible. For example, once you meet your deductible, you pay 50% and your health insurance plan pays 50% up to $5,000; then 100% of the costs for covered services are paid thereafter, up to the plan maximum of $2,000,000.

The coverage available when a mother delivers her child and for her hospital stay and treatment before and after delivery.

Dialysis is a process that takes the place of your kidneys and is used primarily as an artificial replacement for lost kidney function in people with kidney failure.

Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses. Durable Medical Equipment consists of items which:

are primarily and customarily used to serve a medical purpose;

are not useful to a person in the absence of illness, disability, or injury;

are ordered or prescribed by a physician;

are reusable;

can stand repeated use, and

are appropriate for use in the home.

A few examples include:

Blood sugar monitors

Canes

Crutches

Hospital beds

Manual wheelchairs

Nebulizers

Oxygen tanks

Walkers

The amount of money you will pay for a visit to the emergency room. This amount will vary per plan level. For exmaple, some plans may have a co-pay of a certain dollar amount when you visit the ER and others may require you to meet a deductible before they begin to pay for Emergency Room Services.

The cost of ambulance services for an emergency medical situation.

Generic drugs are copies of brand-name drugs. They have the same dosage, safety, strength, administration method, quality, performance characteristics, and intended use. Generic drugs usually cost less than brand-name drugs.

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility.

Examples of skilled home health services include:

Wound care for pressure sores or a surgical wound

Patient and caregiver education

Intravenous or nutrition therapy

Injections

Monitoring serious illness and unstable health status

The goal of home health care is to treat an illness or injury. Home health care helps you get better, regain your independence, and become as self-sufficient as possible.

Care in a hospital where an overnight stay is not necessary.

Specialized care services (symptom management, emotional support, spiritual support and psychosocial intervention), addressing issues most important to patient’s needs and wants at the end of their life focusing on improving the individual’s quality of life.

The amount or percentage that your insurance plan covers in the event of you having to stay in the hospital for 1+night to be treated.

The amount or percentage that your insurance plan covers in the event of your treatment requiring surgery.

Techniques used to create images of the human body for diagnosis, such as CT/PET scans and MRIs.

Infusion therapy involves the administration of medication through a needle or catheter. It is prescribed when a patient's condition cannot be treated effectively by oral medications.

This is the highest amount a health plan will pay towards your medical care during the life time of the plan. Once this max is met, you will have to pay 100% of all future medical bills.

This is the highest amount you are required to pay towards your medical care in a year, including your deductible. For example, once you meet your deductible, you pay 50% and your health insurance plan pays 50% up to $5,000; then 100% of the costs for covered services are paid thereafter, up to the plan maximum of $2,000,000.

Mental health services that require an overnight stay in a facility. For example: the evaluation, stabilization, and treatment for adults and adolescents who are having a psychiatric crisis or a temporary worsening of a chronic mental illness.

Mental health services that do not require an overnight stay in a facility. Outpatient behavioral health services include assessment, treatment, (individual medical evaluation and management, including medication management, individual and group therapy, behavioral health counseling), family therapy, and psychological testing for recipients of all ages.

Non-preferred drugs are usually more expensive and/or newer drugs. Because these drugs often cost more, your copayment may be higher.

Preferred drugs are brand-name drugs that have been on the market for a while and are widely accepted.

The amount covered by an insurance policy for a pregnancy before and after the child is born.

Coverage includes important and free preventive services — which can help you avoid illness and improve your health.

A visit to the doctor for general medical care and basic health needs. Your primary care doctor provides basic medical services, coordinates care, and can refer you to specialists and hospitals.

Prosthetic devices replace a body part or function which may be lost through trauma, disease, or congenital conditions.

Prosthetic devices can include:

Conventional eyeglasses or contact lenses provided after a cataract operation

Outpatient rehabilitation is a form of therapy where patients travel to a clinic or hospital to attend sessions and then return home the same day. Typically, a therapy session lasts from 30 minutes to an hour. When patients are admitted into outpatient programs, it shows that the patients are doing well enough to be home, and their doctors have confidence in them completing their course of therapy through outpatient rehabilitation.

Surgical treatment that does not require an overnight stay once the procedure is completed.

Radiation therapy is a cancer treatment. It uses high doses of radiation to kill cancer cells and stop them from spreading. About half of all cancer patients receive it. The radiation may be external, from special machines, or internal, from radioactive substances that a doctor places inside your body.

A Skilled Nursing Facility is a lot like a nursing home and many times the terms used are one in the same, but a true skilled nursing facility may offer more "skilled" medical expertise and services. Yet, a Skilled Nursing Facility provides skilled nursing care and/or rehabilitation services to help injured, sick, or disabled individuals to get back on their feet.

A visit to a doctor or other health care provider who delivers medical services in a specialized area, such as a dermatologist, neurologist, or gastroenterologist.

Specialty drugs are high-cost drugs used to treat complex or rare conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C, and hemophilia. The drugs are often self-injected or administered in a physician's office or through home health services.

Treatment for a substance use disorder that requires an overnight stay in a facility.

Treatment for a substance use disorder that does not require an overnight stay in a facility.

Temporomandibular disorders occur as a result of problems with the jaw, jaw joint, and surrounding facial muscles. The temporomandibular joint acts like a sliding hinge, connecting your jawbone to your skull. Dysfunction can lead to pain and discomfort. Common treatments include medications, bite guards, and physical therapy.

A medical facility where a person can receive urgent medical attention that is not so severe as to require emergency care from a hospital.

Doctor visits that are typically for the first year after a baby is born.

Any test done for a diagnosis, such as X-ray, blood tests, and biopsy.

A Point of Service (POS) plan has some of the qualities of HMO and PPO plans with benefit levels varying depending on whether you receive your care in or out of the health insurance company's network of providers.

A POS plan may be right for you if:

You're willing to play by the rules and possibly coordinate your care through a primary care physician

A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network . You pay more if you use doctors, hospitals, and providers outside of the network.

A PPO plan may be right for you if:

You want the freedom to choose almost any medical facility or provider for your healthcare needs

You want a portion of out-of-network claims to be covered by your insurance company

You don't want to get referrals before visiting a specialist

Health Maintenance Organization (HMO) Plan. In most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan's list except in an emergency. You may also need to get a referral from your primary care doctor.

An HMO plan may be right for you if:

You're shopping for a plan with lower premiums

You want a plan without a deductible and don't mind having an out-of-pocket limit

You need preventive care services such as coverage for checkups and immunizations

EPO stands for "Exclusive Provider Organization" plan. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. There are no out-of-network benefits.

An EPO plan may be right for you if:

You do not want to get a referral to see a specialist.

You want to receive a much lower negotiated rate with an EPO plan than you would with an HMO or PPO plan

Popularity Among ObamacareUSA.org Consumers: The ObamacareUSA.org Popularity Rating is based on the choices of over 15MM consumers that ObamacareUSA.org services every year. We measure consumer’s propensity to interact with providers and determine their popularity based on these interactions.

Consumer Satisfaction: We survey our consumers on a quarterly basis. This rating is based on the previous survey’s result of the consumer’s satisfaction with the provider.

Size of Carrier: We use recent enrollment numbers to gauge the provider’s reach and popularity.

Type of Provider: We think it’s important you know what type of provider you are working with. Carriers and large brokers generally receive a higher rating than smaller brokers and other types of quote providers.

Provider’s Online Quoting Capabilities: We know that being able to see quotes and check out with a plan online can save you time. We’ve created this special rating to help determine whether a provider has an easy to use online system or not.

Speak to a Health Care Agent

* Disclaimers and Important Information:

ObamacareUSA.org is an independent marketplace and is not a federal or state Marketplace website. ObamacareUSA.org does not provide quotes or sell insurance directly to consumers, is not affiliated with any exchange, and is not a licensed insurance agent or broker. Accordingly, you should not send us (via mail or email) any sensitive information, including personal health information or applications. Any such communications will not be treated as confidential and will be discarded, as, in offering this website, we are required to comply with the standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information.

This website may not display all data on Qualified Health Plans being offered in your state through the Marketplace website. To see all available data on Qualified Health Plan options in your state, visit your state Marketplace website or go to the Health Insurance Marketplace website at www.HealthCare.gov

Advertised Pricing:

There are several factors that impact your monthly premium; including, but not limited to your age, geographical location, annual income, dependents, and the type of plan you choose. Monthly premiums do not include out-of-pocket costs.

The advertised price may not be typical. It was generated using the Kaiser Family Foundation's subsidy calculator that was accessed on June 1, 2016. The following parameters were used: 21 year old adult, non-tobacco user, annual income of $20,500 in 2016, no children, and no available coverage through a spouse's employer. The resulting monthly premium was $50 per month (or $600 per year after $1,617 in subsidies) for a Bronze Plan. Even when using the same parameters, this result is subject to change.